What is the dosage of Neoral (Cyclosporine)?

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Last updated: February 13, 2025 • View editorial policy

From the Guidelines

The dosage of Neoral (Cyclosporine) is up to 5 mg/kg/d, given in two divided doses.

Key Points

  • The starting dose of Cyclosporine is typically 3 to 6 mg/kg per day with a maximum of 200 mg for both adults and children 1.
  • In the context of glomerular diseases, the dose of Cyclosporine is up to 5 mg/kg/d, given in two divided doses, with a target 12-hour trough level of 60-150 ng/ml 2.
  • The dose of Cyclosporine may need to be adjusted based on individual patient response and tolerance, with monitoring of trough drug levels to limit toxicity 2, 1.
  • Cyclosporine has been shown to be effective in inducing remission in patients with idiopathic glomerular disease associated with the nephrotic syndrome, with response rates ranging from 60 to 75% 3, 4.
  • The use of Cyclosporine in children with idiopathic nephrotic syndrome has also been studied, with reported remission rates of up to 82.1% 4.
  • It is essential to monitor patients on Cyclosporine for potential side effects, including gingival hyperplasia, hypertension, nephrotoxicity, and nausea 1.

From the FDA Drug Label

The initial dose of cyclosporine [MODIFIED] should be 2.5 mg/kg/day. Cyclosporine [MODIFIED] should be taken twice daily, as a divided (1.25 mg/kg b.i.d.) oral dose. Patients should be kept at that dose for at least 4 weeks, barring adverse events. If significant clinical improvement has not occurred in patients by that time, the patient's dosage should be increased at 2 week intervals. Based on patient response, dose increases of approximately 0.5 mg/kg/day should be made to a maximum of 4 mg/kg/day. Dose decreases by 25% to 50% should be made at any time to control adverse events, e.g., hypertension, elevations in serum creatinine (≥ 25% above the patient's pretreatment level), or clinically significant laboratory abnormalities.

The dosage of Neoral (Cyclosporine) is 2.5 mg/kg/day initially, with possible increases to a maximum of 4 mg/kg/day.

  • The dose should be divided into two daily doses.
  • Dose adjustments should be made based on patient response and adverse events.
  • The dosage may need to be decreased by 25% to 50% to control adverse events 5.

From the Research

Dosage of Neoral (Cyclosporine)

The dosage of Neoral (Cyclosporine) can vary depending on the individual patient and the specific medical condition being treated.

  • According to 6, intravenous cyclosporine doses range from 2-9 mg/kg/d and oral doses range from 10-50 mg/kg/d.
  • The dosage should be individualized based on the clinical status of the patient as well as blood concentrations of the drug 6.
  • Monitoring cyclosporine blood concentrations is necessary in the postoperative management of transplant patients 6, 7, 8.
  • A single concentration (C2) taken two hours after cyclosporine administration with the microemulsion formulation better predicts exposure and events than the trough concentration (C(0)) 7.
  • The C2 level is considered a better reflection of immunosuppressive efficacy than the trough concentration 7.
  • Target values for C2 levels have been proposed for liver and renal transplant recipients, but require further prospective validation 7.
  • Neoral dose monitoring with C2 compared to trough levels (C0) has been shown to have clinical benefits in stable heart transplant patients 9.
  • Dosages of less than 5 mg/kg/day rarely cause renal side effects 10.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Cyclosporine.

Drug intelligence & clinical pharmacy, 1985

Research

Therapeutic drug monitoring of cyclosporine.

Transplantation proceedings, 2004

Research

Cyclosporin clinical pharmacokinetics.

Clinical pharmacokinetics, 1993

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.